Knee Osteoarthritis

Knee pain is often associated with osteoarthritis of the knee joint. Millions of people all around the world suffer from it. Joint replacement surgery is not always necessary! There are effective ways to treat osteoarthritis of the knee that eliminate the causes and the symptoms. The best results can be achieved thanks to Orthokine ® therapy.  The clinic for regenerative medicine SPORT-MED (Dr Jan Paradowski) also offers stem-cell therapy treatment (MSC – Mesenchymal Stem Cells). The most important thing for every patient is to understand the causes and symptoms of their illness as well as the possible treatment methods. If we find that surgery is necessary, we perform minimally invasive procedures and as a last resort, we choose an appropriate implant. Read the article and find out more about osteoarthritis of the knee. 

►I recommend this article about Orthokine, a biological, anti-inflammatory, regenerative therapy that is used to treat osteoarthrosis of the joints and spine – click here

Content:

1. What causes knee pain?
2. Who is affected by osteoarthritis?
3. Causes of osteoarthritis of the knee
4. Symptoms of osteoarthritis of the knee
5. How is osteoarthritis of the knee diagnosed?
6. How is osteoarthritis of the knee treated?

 What causes knee pain?

Osteoarthritis of the knee (arthrosis, degeneration, musculoskeletal inflammation) is a state of chronic joint inflammation. While age is a major risk factor, this disease can also affect young people. The inflammation causes damage to the cartilage, as well as the tendons, the meniscus and the other joint structures. However, it is the loss of cartilage that plays the main role in determining the development of arthritis. The cartilage, which is the natural cushioning material between the bones, is weakened. When this happens, the internal bones of the joint move closer to one another (thickness loss) and rub against each other. The loss of cartilage exposes the ends of the nerve fibres, which are stimulated by each movement. Friction causes pain, swelling (which is visible on the ultrasound and sometimes to the naked eye), rigidity, difficulty walking, and the formation of bone spurs, (visible on X-rays and ultrasound tests). Chronic inflammation that damages the cartilage is at the root of the disease. Skilful control of the inflammation (Orthokine ® therapy), cartilage regeneration and paying attention to the biomechanical attributes of the joint (rehabilitation) are crucial in order to keep the disorder under control. 

Who is affected by osteoarthritis?

Osteoarthritis is the most common form of arthritis. Even though it can occur in young people, the chance of developing osteoarthritis rises after the age of 45.  Numerous studies suggest that osteoarthritis of the knee joint is one of the most common forms. Studies also show that women are more at risk of developing arthritis.

Causes of knee osteoarthritis

The most common cause of knee arthritis is age. Almost everyone will eventually develop some degree of osteoarthritis. However, there are several factors that increase the risk of developing arthritis, even at a young age:

• Age – the ability of cartilage to heal decreases with age. However, the amount of movements the joint performs increases, as does the amount of small overuses and sometimes more serious injuries.
• Obesity – excess weight increases pressure on the knee joint. Each extra kilogram you gain adds 3-4 extra kilograms of weight on the knee. Body fat produces substances that travel via the bloodstream cause damage to the joint.
• Atherosclerosis (poor blood supply to the underside of the bones),
• Diabetes
• Hormonal imbalance – it has been shown that lowering body mass by 5 kg alleviates pain by up to 50%.
• Heredity – genetic factors play a significant role in the development of osteoarthritis. If a parent suffers from arthritis or a rheumatic disease, this significantly increases the patient’s risk of developing it. Patients can also inherit other problems such as limb deformations (curvature), which causes too much pressure on the knee and the development of degenerative changes. It also affects patients with deformities such as knock-knees and bow-leggedness. 
• Sex - women over the age of 55 are more likely to develop the disease than men of the same age. Hormones are one of the factors that influence this.
• Repetitive stress injuries – generally speaking, this kind of injury is usually a result of the type of job the patient has. People whose jobs involve kneeling or heavy-lifting are more likely to develop osteoarthrosis as a result of constant pressure on the knee joint.
• Sport - professional athletes, especially football players, tennis players, basketball players and runners are more at risk of developing osteoarthritis of the knee. A large number of my patients are people who play recreational sports, usually intensively. It is most often runners who have problems with their knees (and feet). This means that athletes should take precautions to avoid injury. You can achieve a lot by doing relatively simple things. It is important to remember to do regular, moderate strengthening and stretching exercises. In reality, weak muscles surrounding the knee affect its stability and cause the cartilage to rub, leading to the development of osteoarthritis. Muscles that are not trained correctly also suffer from contractures, which puts pressure on the ligaments, entheses (that connect the muscle to the bone) and tendons. If the biomechanics are disturbed in such a way, this causes the elements of the knee to deteriorate more quickly. It is very important to train properly, regenerate after exercise, and eat a balanced diet. Sometimes it is important to take dietary supplements and have joint injections (e.g. hyaluronic acid, platelet-rich plasma, Orthokine).
• Other causes – people who suffer from rheumatoid arthritis, the second most common kind of arthritis, are more likely to develop degenerative changes. Such patients should see a rheumatologist about treating their primary disease as well as undergo orthopaedic treatment. People with certain metabolic disorders (e.g. iron overload or excess growth hormone) or connective tissue defects (e.g. hypermobility syndrome) are also more at risk of developing osteoarthritis. Blood inside the joint seriously damages the cartilage. This is why haemophilia can lead to serious damage and the need for joint replacement surgery.

Therefore it is important to find the cause in order to decide on the correct treatment. It is important to treat each case individually and choose the safest and most effective treatment method for each patient.

When conservative therapies no longer bring the desired effects, patients are advised to undergo knee replacement surgery – knee endoprosthesis, also called an allograft.

To find out more about knee replacement surgery, click here.

Symptoms of osteoarthritis of the knee

This disease causes symptoms that differ depending on the degree of its progression and the age, physical activity and predispositions of the patient. That said, the most frequent symptoms are:

• knee pain which increases when you are active and gets better when you rest. It is caused by exposure of the nerve ends of the underside of the knee, which is a result of damaged cartilage.
• swelling
• a feeling of warmth in the knee
• stiffness in the knee, especially in the morning or after longer periods of rest, e.g. after sitting in the office all day or sitting in front of the television.
• decreased mobility of the knee which makes it difficult to get up off a chair or get out of the car. It makes it more difficult to use the stairs and even walk around.
• a creaking, crackly sound, particularly as a result of sudden knee movement. 
• Many patients claim that changes in the weather can affect knee pain and problems.

How is osteoarthritis of the knee diagnosed?

Osteoarthritis of the knee is diagnosed by taking the patient’s medical history, a precise description of the symptoms and by doing orthopaedic tests. It is important to tell the doctor what causes the pain to get better and worse. It is also worth finding out if someone in your family has ever suffered from osteoarthritis or a rheumatic disease. 

The doctor could recommend additional tests such as:

• An X-ray that will show the degree of bone changes, e.g. joint space narrowing, osteophites (bone spurs), subchondral sclerosis, sharpening of the intercondylar eminence, poor limb alignment.
• Ultrasound – click here to find out more.
• MRI (magnetic resonance imaging) – used most often when x-ray and ultrasound images do not show the cause of the pain clearly. 
• Blood test – to rule out other conditions that could be causing the pain such as rheumatic diseases, lyme disease etc.

How is osteoarthritis of the knee treated?

Developments in orthopaedics in recent years have opened up new, speculative methods of treating knee osteoarthritis. More and more we are able to put off or avoid joint replacement surgery altogether by administering modern conservative methods, mainly Orthokine® therapy and growth factors (platelet-rich plasma). It makes use of the body's natural ability to heal tissue and bone cartilage. 

The primary goal of treating knee osteoarthritis is to relieve pain and restore mobility and the possibility of walking. The treatment plan must be suited to each individual patient. As well as Orthokine® therapy and growth factors, the treatment plan will usually include a combination of the methods described below.

Non-surgical treatment

1) Weight loss. Loosing even just a few kilograms can significantly relieve knee pain.

2) Exercise. Strengthening and stretching the muscles around the knee joint improves the stability and biomechanics of the joint and decreases pain.

3) Pain relievers and anti-inflammatory drugs. There are many NSAIDs (non-steroidal anti-inflammatory drugs) that are available on the market. Prescription drugs include diclofenac, ketoprofen, and non-prescription drugs include ibuprofen. They help alleviate pain and treat inflammation. However, it is important to remember not to take pain medication for more than 10 days without consulting with your doctor. If you take them for a longer period of time, you are more likely to suffer from side effects. Among the most serious are:

• Bleeding from the upper gastrointestinal tract (stomach, duodenum) – especially in the USA where NSAIDs are more readily available than doctors, bleeding has become a common cause of death.
• Gastric and duodenal ulcers (damage to the mucous membrane caused by hydrochloric acid in gastric acid).
• Gastritis and duodenitis
• Decreasing the blood’s ability to clot
• Kidney failure
• Bone marrow failure

That is why it is very important to use other treatment methods that do not cause side effects. In this case Orthokine is recommended, which locally blocks the joint inflammation without causing side effects. 

4) Corticosteroid injections, or steroid blocks for the knee – steroids are powerful anti-inflammatory drugs that alleviate pain. Unfortunately they cause systemic negative side effects (e.g. hormonal imbalance, diabetes), as well as local negative side effects (e.g. irreparable damage to the articular cartilage). This kind of therapy should only be used by patients who will soon undergo knee replacement surgery (called an allograft) An alternative is Orthokine therapy, a strong anti-inflammatory treatment that does not cause side effects.

5) Ultrasound-guided intervention – injecting the affected areas with the appropriate medicine under the guidance of ultrasound. A highly effective method of treatment. It requires a highly able and experienced orthopaedist. To find out more about the use of ultrasound, click here

6) Hyaluronic acid joint injections – viscosupplementation. When injected into the knee, hyaluronic acid increases the viscosity of the joint fluid and therefore its lubricating properties. We reduce the friction between the surfaces of the cartilage, rigidity and crackling sounds, alleviate knee pain, and also improve mobility. 

7) Glucosamine, collagen and chondroitin tablets. Studies have not proven their effectiveness but they are in common use.

8) Anti-inflammatory ointments  – e.g. Voltaren, Reparil, Powergel, Ketonal. Topical applications (on the skin) can temporarily treat the problem. However, they are extremely limited due to weak penetration through skin barrier, hypodermic tissues and fascias. Sprays such as Diky 4% ale Ketospray forte allow for better penetration thanks to the liposome structure.

9) Knee supports and orthoses. They are mainly recommended for injured anterior cruciate ligaments and other ligaments. They help to stabilise the knee preventing further damage to the cartilage and meniscus.

10) Physiotherapy.   Physiotherapy is a very important part of the process. Strengthening and stretching exercises are often needed. The most important parts are massages and manual therapy conducted by an experienced physiotherapist. (E.g. cryotherapy, ultrasound, iontophoresis or TENS nerve stimulation) help the process. Acupuncture can also be effective. It is used on a daily basis in hospitals in Germany. Physiotherapy will also teach you different ways to strengthen your muscles and increase the elasticity of your joints at home. It will also show you how to carry out your daily activities without putting too much pressure on your knee. Everyday in my clinic I work with the best physiotherapists. Thanks to our individual, multidimensional approach to patients, we achieve great results.

Surgery

Surgery has its advantages and disadvantages. If you are correctly assessed for surgery (there has been a correct assessment of the injured structures and of the possibility of their repair), we see a quick, significant improvement. However, all surgery carries some risk which is why it is performed only if the damage to the internal structures is serious and non-surgical treatment would not help. The most frequently performed surgeries to treat osteoarthritis of the knee are: arthroscopy, osteotomy and arthroplasty.

Arthroscopy – minimally invasive arthroscopic procedure. It allows us to safely repair the majority of internal structures. We insert an elongated camera and instruments into the knee through two incisions at the front of the knee that are a few millimetres long. This procedure is often performed on athletes (complicated ligament reconstruction, cartilage reconstruction, stitching the meniscus) as well as on relatively young patients in the early phases of arthrosis (generally younger that 60 years old). In the first case it is possible for athletes to return to professional sport after a short while. In the second, we give people a chance to alleviate pain and put off or prevent joint replacement surgery 

Osteotomy – cutting the bone to correct its alignment and interaction. We relieve the affected part of the knee which is most often the middle part. Osteotomy is often recommended in the case of a broken bone near the knee (e.g. a break at the end of the tibia) and it didn’t heal properly. The success of the procedure depends highly on the patient’s assessment and how the procedure is conducted. An advantage of this procedure is that you can (temporarily) put off replacement surgery. A disadvantage is the need to wear a cast for a long period of time to allow the bone to heal.

Knee replacement surgery (allograft) – a serious surgical procedure where we excise the ends of the joint bones and then put a metal endoprosthesis in their place (with so-called bone cement or mechanically). Polyethylene, ceramic and metal implants form the new joint surfaces. Either the whole joint or just a part of it can be replaced. The aim of the procedure is to restore mobility and eliminate pain. In most cases, this is achieved. However, it is a serious and straining operation that you need to be well prepared for. Complications, even though they are rare, can be very serious (e.g. bone infections, loosening of the prosthesis, embolism/blood clot related complications). This is why joint replacement surgery should only be a last resort for patients who are over the age of 55 and who suffer from an acute degenerative disease and have tried intensive conservative treatment (e.g. orthokine therapy) but they didn’t work. We cannot clear for surgery elderly patients who suffer from poor blood circulation or respiratory problems, hormonal imbalance (mainly related to the thyroid), who have had a stroke or suffer from other serious conditions. For these patients we recommend intensive conservative treatment. However, despite the risk, the general results from joint replacement surgeries have been very good in recent years.

In summary, it is necessary to emphasise the important role of an early diagnosis and constant contact with your orthopaedist. The best alternatives to surgical treatment are Orthokine® therapy,  platelet-rich plasma with growth factors, viscosupplementation and professional rehabilitation suited to your individual needs. In my clinic I monitor the process of osteoarthritis and I choose appropriate treatment methods in co-operation with the best radiologists, rheumatologists and physiotherapists.

Read more about: Effectiveness of intra-articular therapies in osteoarthritis: a literature review - click here.